Bush and Company Rehabilitation Limited provide a bespoke case management service for people who have experienced catastrophic life changing injuries, supporting both the individual and their families by providing access to the services and support they need. They provide personal care to people who have complex needs following a catastrophic accident or incident, in their own homes. On the day of our inspection there was one person receiving a regulated activity from the service. However, there were 64 people using the service nationwide, receiving care and support through an employment support service also managed by the provider.

The inspection was announced and took place on 6 and 7 April 2016.

The service had two registered managers. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The person receiving care felt safe with the support they received from the service. Staff demonstrated an awareness of what constituted abuse and understood the relevant safeguarding procedures to be followed in reporting potential abuse. Potential risks had been identified, and plans implemented to enable the person to take positive risks and to live as safely and independently as possible. Robust recruitment checks took place in order to establish that staff were safe to work before they commenced employment. There were sufficient numbers of consistent staff available to meet the person's care and support needs. Medicines were managed safely, in line with best practice guidelines; and staff had been provided with training in the safe handling of medicines.

People were matched with staff that were aware of their care needs. Staff received the appropriate training and support to enable them to carry out their roles and responsibilities appropriately. Staff received an induction at the start of their employment and this was supplemented with regular training, which provided them with the knowledge and skills to meet individual needs in a person centred manner. They were very well supported in respect of supervision and appraisal.

Consent was sought in line with current legislation and guidance. The service worked in line with the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

The person in receipt of care was supported to access suitable amounts of nutritionally balanced food and staff ensured that an appropriate nutritional intake was received. Staff also worked closely with other professionals to ensure that health and well-being needs were fully met and to ensure that where possible, any rehabilitation goals were met.

Staff used kindness and compassion in their dealings with people. They had established positive and caring relationships and forged bonds. People and their representatives were enabled to express their views and be involved in making decisions in relation to their care and support. Staff ensured they promoted privacy and dignity.

Care was provided that met assessed needs. Care plans were updated on a regular basis, or as and when needs changed. The person in receipt of care was supported to follow their interests and engage in activities which interested them. The provider’s complaints procedure was made accessible which ensured that people or their representatives would be aware of how to raise a complaint if the need arose.

The culture at the service was open and inclusive. The registered manager led by example, which inspired staff to deliver a quality service. There were quality monitoring systems in place. These were used to good effect and to drive continuous improvements.

We spoke with three members of staff who all told us how the care they gave to support people was making a great difference to people’s lives. One member of staff told us that a person living at home was more confident and happier about their own self-worth. Another member of staff told us that the person they provided care for chose their own items when out shopping and they were working together to build self-confidence to speak for themselves in public places.

We spoke with a relative of one person who used the service, they told us “I am so happy with the care that he receives, I know that I can trust (the staff member) because when they don’t know that I am there I can hear them laughing and giggling and having a great time.”, and “his confidence has improved so much that he can go out to the shops and swimming, he never used to do that.”

We found that the provider had comprehensive risk assessments and care plans in place that staff could follow to ensure that people received care that met their needs. We found that staff had the relevant checks made before they started to work with people and staff had received training that was relevant to their roles and would enable them to meet people’s needs. We saw that the provider maintained clear records for the quality monitoring of the service.

Bush & Company Rehabilitation Limited care agency was registered to provide personal care with the Care Quality Commission on 28 November 2011. At the time of our visit we were informed that the agency was providing 24 hour care and support to one person living in the community, through a team of eight care staff.

We looked at the person’s care plan and risk assessments and we carried out telephone surveys with the staff and the representative of the person who used the service. The representative acting on behalf of the person told us they had been involved in setting up the person’s care package with the agency. They also confirmed they had been provided with all the information they needed about the agency and the services provided. They told us they had regular meetings with the staff to discuss the care the person received. They said “I’m very satisfied with the service; everything is going very well”.